Attend the MT Diabetes Professional Conference
Free & virtual on October 23! Earn free, pharmacy continuing education credits and learn more about caring for your patients with diabetes and other comorbidities. This conference offers a wide variety of topics from fetal origins of adult disease to promoting positive changes in health and behavior, plus much more. Check out the agenda, sign up, and join us for this great, annual conference.
Smart Insulin Pens for Easier Management
Many people find that they need help with insulin dosing but have some reservations about moving directly to an insulin pump. Keeping up with doses given and making the calculations necessary for mealtime and correction bolus doses can be troublesome and a barrier to adequate control. Those using insulin, who have never been taught how to make calculations for carb counting and correcting high glucose, are at a particular disadvantage. Bolus calculators have been introduced by several companies and have been shown to lower A1c by 0.7-1%. Enter the smart insulin pen (SIP).
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Using a mobile app, this smart pen is a Bluetooth® enabled insulin pen integrated with a diabetes management system. It is approved for use with lispro (Humalog®), aspart (Novolog®) and faster aspart (Fiasp®) cartridges. The battery-operated pen lasts for about a year and is intended for use only at mealtime or correction bolus dosing.
Currently, the Companion Medical InPen is the only FDA-approved smart pen available.
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Features:
- Monitors insulin temperature
- Reminds when dose is due
- Records injections and injection time
- Calculates individual patient doses based on several different parameters
- Correction doses calculated based on self-monitoring blood glucose (SMBG) and built in bolus calculator
- Mealtime coverage based on blood glucose (BG), carb count, and target BG
- Suggests the bolus dose based on the above factors plus insulin on board
- Allows doses down to 0.5 units
- The InPen app is downloadable from the Apple App Store or Google Play and reports can be emailed or faxed to a clinician for remote monitoring.
- Synchronizes with Dexcom G6 CGM system
- Integrates with certain blood glucose meters
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For clinicians
- Access to patient data via the Insight mobile app.
- Data interpreted more easily because of reporting system
- Good option in the age of virtual appointment with remote monitoring capability
- Patient training is done virtually by certified trainers
Disadvantages:
- It’s still an injection
- Patient must be teachable and committed
- Requires a separate injection of basal insulin
Smart pens can be an option for people who are committed to managing their diabetes with multiple daily injections. One is still committed to taking the injections, meaning you can’t be deterred. For these people the pen technology can simplify accurate mealtime dosing. Correcting high blood sugar can be confidently done because of the insulin on board and correction factor (sensitivity factor) capability. The device is covered by most commercial insurance and certain patients will qualify for a reduced copay of $35 for the pen itself.
Looping: The DIY Solution*
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This is a fascinating and almost unbelievable story about people who organized and built a do-it-yourself (DIY) diabetes technology movement. While not approved by the Food and Drug Administration (FDA), there is a good chance some of the patients you encounter are looping.
Here is a little bit of a start and you are encouraged to look at the referenced websites if interested in more information.
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#WeAreNotWaiting is the mantra for the growing number of people who are tired of waiting on the “innovation bottleneck that’s holding us back.” It is a worldwide movement that began with the first ever DiabetesMine D-Data ExChange at Stanford University in 2013. That discussion involved a number of do-it-yourself diabetes gurus and entrepreneurs as they talked about the issues they faced and how some of them have decided not to wait any longer. Here are some websites related to the movement that can provide more information.
- According to the OpenAPS website, it is a “simplified Artificial Pancreas System (APS) designed to automatically adjust an insulin pump’s basal insulin delivery to keep blood glucose in a safe range overnight and between meals” On this website, you can get the directions for building your own APS using readily available equipment.
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Nightscout is an open source DIY project for “getting real time access to continuous glucose monitor (CGM) data via a personal website, smartwatch, or apps and widgets available for smartphones.”
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Tidepool is an organization that provides free software for diabetes management.
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Loop is an app template for building an automated insulin delivery system.
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Looped is a Facebook page for loopers.
*In May, 2019, the FDA issued this statement regarding looping systems, "These unauthorized diabetes management devices have not been reviewed by the FDA to ensure they provide a reasonable assurance of safety and effectiveness for their intended use. Use of unauthorized devices could result in inaccurate glucose level readings or unsafe insulin dosing, which can lead to injury requiring medical intervention or death.”
References:
Companionmedical.com
American Diabetes Association Guidelines 2020
Association of Diabetes Care and Education Specialists Conference August 2020
Diabeteseducator.org
Healthline.com article #wearenotwaiting
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